The vaccine against human papillomavirus (HPV) was introduced during the 2009/2010 academic year as part of the childhood immunisation programme for girls in their last year of primary school. The HPV vaccine protects against the types of HPV that cause at least 70 per cent of cervical cancer cases. To date, anyone who has wanted to receive the vaccine, apart
7 Statistics Norway (2014d)
8 Halrynjo, Teigen & Nadim (2014)
39 from the girls in Year 7, has had to pay for it through her own doctor or at a public health clinic.
HPV-related cancers have a social dimension, in that women of lower education and income are less likely to have Pap smears performed, are slower to seek medical help after symptoms appear, and are less willing and less able to pay for HPV vaccinations themselves.
For a two-year period starting in 2016, the Government will offer free catch-up vaccinations against human papillomavirus (HPV) for all women up to 26 years of age.
By international standards Norwegian women enjoy good reproductive health. This is thought to be related to high levels of education, women’s status and self-determination in health matters. Maternal mortality in Norway is very low and national guidelines have been developed for prenatal, birth and postnatal care.
The average age of women giving birth for the first time is rising. At base, this is an unfortunate development because mother and child alike are more prone to complications with increased maternal age. High age before a first pregnancy increases the need for assisted reproductive technology. Since 2007, more than 3 per cent of children in Norway have been born after assisted reproduction.
The Norwegian Directorate of Health has worked in several areas to improve reproductive health services and women’s reproductive prospects. Among the most important measures are a development strategy for midwifery and a guide to quality standards for maternity care. The guide will provide the basis for developing better and more predictable maternity care
services, with quality at every stage. Quality standards are being accentuated, and
requirements for maternity units clarified. Postnatal care and safety guidelines issued in 2014 include 41 recommendations relating to the infant, mother and family. Also published in 2014 were national professional guidelines on detecting violence while providing prenatal care. The guidelines recommend that health care personnel broach the topic of domestic violence as early as possible in pregnancy, as part of routine clinical practice.
Hospitals have increased their focus on childbirth and prenatal care in collaboration with the primary care service. Girls and women who have been exposed to genital mutilation may be prone to complications during childbirth. Outpatient clinics, paediatric departments and maternity departments will provide information about health problems and other possible medical consequences of genital mutilation. Each health region has a woman’s clinic with a
40 special responsibility to follow up girls and women at risk of, or exposed to, genital
mutilation. The clinic offers counselling, physical examination, treatment and the possibility of de-infibulation surgery.
In recent decades abortions have declined. The abortion rate among certain groups of women with immigrant backgrounds is far higher than in the general female population. Suitably adapted information and easy access to contraception are measures capable of lowering the number of abortions. Oslo University Hospital and the city of Oslo operate a free evening outpatient clinic for women with immigrant backgrounds who need health information, postnatal monitoring or guidance on contraception and family planning.
The Government has ensured that nurses and midwives have prescribing authority for all types of hormonal contraception and copper IUDs. An extended right permitting nurses and midwives to prescribe any type of hormonal contraceptive method to women over 16 was adopted on 22 March 2015 with effect from 1 January 2016. This measure will make all types of contraception more easily available to women over 16.
Few teenagers today have children. Most teens who do become pregnant choose to have an abortion. In 2013, 19 women aged 15 or younger and 162 women aged 16–17 gave birth to a child. These accounted for 0.3 per cent of all births. The school health service and public health clinics, where health personnel counsel young people on physical, psychological and sexual health matters, are well attended. In many places such services play an important role in sex education. The authorities have strengthened the school health service and public health clinics for a number of years.
The authorities will be drawing up an overall sexual-health strategy, including measures to prevent unwanted pregnancies. This strategy is scheduled for submission in 2016. A strategy on young people’s health will also be prepared.
Research on the effects of pregnancy and birth on women’s health in general has been funded by the Research Council of Norway as part of the focus on women’s health. One result is that potential childbirth complications such as urinary incontinence and accidental bowel leakage have been added to the topics covered in Nord-Trøndelag county’s health survey. Previously, the topics had received little attention. One project that received funding was a European study on gender-based violence and childbirth (funded in the 2011–2014 period). The study’s goal was to see if rape or other involuntary sexual activity has negative consequences for pregnant women.
41 Excessive body weight is a growing problem, including for women with immigrant
backgrounds. Over 50 per cent of Turkish women and about 40 per cent of Pakistani women are obese. Many public health clinics provide excellent services to immigrant women, including breastfeeding groups and nutritional guidance.
Every fourth pregnant women in Norway is overweight, increasing the risk of pregnancy complications and future health challenges for both mother and child. Norway is participating in an EU project to develop models to prevent obesity among pregnant women.
The Medical Birth Registry is a nationwide record containing data on all births in Norway.
The registry helps to clarify the causes and consequences of health problems related to pregnancy and childbirth, and to monitor the incidence of congenital disorders. All maternity units in Norway report births to the Medical Birth Registry.